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U-shaped association of central pulse pressure with long-term prognosis after ST-segment elevation myocardial infarction

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Abstract

The relationship between central pulse pressure (CPP) measured at the time of primary percutaneous coronary intervention (PPCI) and long-term prognosis after ST-segment elevation myocardial infarction (STEMI) has not been investigated. CPP measurements were performed in 1348 patients with STEMI (327 women; mean age 62.5 ± 12.1 years) undergoing PPCI. Aortic systolic and diastolic blood pressure was measured before intervention. The primary outcome was 8-year all-cause mortality. The median [25–75th percentile] CPP value was 55.0 [43.0–70.0] mmHg. CPP correlated negatively with heart rate (P < 0.001), body mass index (P = 0.007), Killip class (P < 0.001) and initial area at risk (P < 0.001) and positively with age (P < 0.001), female sex (P < 0.001), diabetes (P = 0.012), arterial hypertension (P < 0.001) and glomerular filtration rate (P = 0.004). There were 181 deaths over the follow-up. In patients with CPP within the 1st, 2nd and 3rd tertiles, the Kaplan–Meier estimates of mortality were 17.3%, 10.8% and 24.2%, respectively; univariable hazard ratio [HR] =1.52, 95% confidence interval [CI] 0.99 to 2.32; P = 0.055 for tertile 1 vs. tertile 2 and HR =2.09 [1.36–3.21]; P < 0.001 for tertile 3 vs. tertile 2. For CPP values lower than 35 mmHg and higher than 71 mmHg, the association between CPP and all-cause mortality was significant (HR =1.276 [1.004–1.621] for the 35 mmHg value and HR =1.289 [1.003–1.657] for the 71 mmHg value) compared with the CPP reference value (54 mmHg). After adjustment, the association between CPP and all-cause mortality was attenuated (P = 0.304). In patients with STEMI undergoing PPCI there is a U-shaped association between CPP and mortality up to 8 years after PPCI.

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Authors and Affiliations

  1. Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Lazarettstrasse 36, 80636, Munich, Germany

    Gjin Ndrepepa, Salvatore Cassese, Sebastian Kufner, Erion Xhepa, Massimiliano Fusaro, Heribert Schunkert & Adnan Kastrati

  2. I. Medizinische Klinik, Klinikum Rechts Der Isar, Technische Universität, Munich, Germany

    Karl-Ludwig Laugwitz

  3. DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany

    Karl-Ludwig Laugwitz, Heribert Schunkert & Adnan Kastrati

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  1. Gjin Ndrepepa
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  2. Salvatore Cassese
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  3. Sebastian Kufner
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  4. Erion Xhepa
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Correspondence to Gjin Ndrepepa.

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Ndrepepa, G., Cassese, S., Kufner, S. et al. U-shaped association of central pulse pressure with long-term prognosis after ST-segment elevation myocardial infarction. Heart Vessels 34, 1104–1112 (2019). https://doi.org/10.1007/s00380-019-01344-x

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